Lyme Disease and Mental Health: Anxiety, Depression, and Brain Fog
Lyme disease may contribute to anxiety, depression, and brain fog
Neuropsychiatric symptoms can interfere with daily functioning and recovery
Persistent symptoms may require a broader clinical evaluation
Lyme disease can affect far more than joints and muscles. Some patients experience anxiety, depression, irritability, sleep disruption, panic symptoms, or cognitive problems such as brain fog and slowed processing speed. These neuropsychiatric symptoms may emerge during acute infection or persist after treatment in some individuals.
Because many of these symptoms overlap with primary psychiatric disorders, patients are sometimes misdiagnosed before Lyme disease or another tick-borne illness is considered. In some cases, individuals report worsening fatigue, impaired concentration, memory difficulties, or emotional changes that interfere with work, school, and daily functioning.
Neuropsychiatric symptoms linked to Lyme disease
Recent reviews have highlighted that Lyme disease and post-treatment Lyme disease syndrome (PTLDS) may involve fatigue, cognitive dysfunction, anxiety, depression, sleep disruption, and reduced occupational functioning in some patients.
Researchers have proposed several mechanisms that may contribute to persistent neuropsychiatric symptoms, including neuroinflammation, altered neural signaling, autonomic dysfunction, immune dysregulation, and small fiber neuropathy.
A 2023 review by Biniaz-Harris and colleagues noted that cognitive complaints such as memory problems and slowed processing are reported in up to 90% of patients with PTLDS. The authors also described associations between Lyme disease and mood disorders, anxiety, sensory hyperarousal, and functional impairment.
Brain fog and cognitive dysfunction
Patients with neurologic Lyme disease or PTLDS may describe:
- difficulty concentrating
- word-finding problems
- short-term memory issues
- slowed thinking
- mental fatigue
- difficulty multitasking
These symptoms are commonly referred to as “brain fog.” Some imaging studies have demonstrated abnormalities involving cerebral blood flow, white matter structure, and microglial activation in patients with persistent Lyme symptoms.
Up to 90% of patients with post-treatment Lyme disease syndrome (PTLDS) report cognitive symptoms such as brain fog, memory issues, and slowed processing. Advanced imaging (PET, fMRI, DTI) in these patients shows evidence of inflammation, glial activation, and changes in white matter structure.
Anxiety and depression in Lyme disease
Anxiety and depression are among the most frequently reported psychiatric symptoms associated with Lyme disease. Patients may experience panic attacks, irritability, mood swings, insomnia, or emotional distress related to persistent physical symptoms and delayed diagnosis.
Some studies suggest an increased risk of affective disorders and psychiatric medication use following Lyme disease, although findings across studies remain mixed. Careful clinical evaluation is important because symptoms may overlap with other neurologic, inflammatory, or psychiatric conditions.
Persistent symptoms can be emotionally exhausting for patients who struggle to maintain work, relationships, or daily routines while searching for answers.
Autonomic dysfunction and sensory symptoms
Some patients with persistent Lyme symptoms also develop autonomic dysfunction or small fiber neuropathy, which may contribute to dizziness, sensory symptoms, exercise intolerance, palpitations, and cognitive fatigue.
These symptoms may overlap with anxiety or panic disorders, particularly when patients experience rapid heart rate, lightheadedness, chest discomfort, or internal tremulousness.
Learn more about autonomic dysfunction in Lyme disease.
Why diagnosis may be delayed
Neuropsychiatric Lyme disease may be difficult to recognize because:
- a tick bite may never be seen
- the classic rash may be absent
- symptoms can fluctuate
- standard testing has limitations in early disease
- patients may initially present with cognitive or psychiatric complaints
Delayed recognition may prolong suffering and contribute to functional decline. Clinicians should consider Lyme disease in patients with compatible symptoms, possible tick exposure, neurologic findings, or unexplained multisystem illness.
Frequently Asked Questions
Can Lyme disease affect mental health?
Yes. Lyme disease may be associated with anxiety, depression, irritability, sleep disruption, panic symptoms, and cognitive complaints in some patients.
Can Lyme disease cause anxiety or panic attacks?
Some patients report anxiety, panic attacks, internal tremulousness, palpitations, or sensory sensitivity during Lyme disease or persistent post-treatment symptoms.
Can Lyme disease cause brain fog?
Yes. Brain fog may include poor concentration, memory problems, slowed processing, word-finding difficulty, and mental fatigue.
Can Lyme disease symptoms be mistaken for psychiatric illness?
Yes. Neuropsychiatric Lyme symptoms may overlap with primary psychiatric disorders, especially when fatigue, pain, neurologic symptoms, or autonomic dysfunction are also present.
Why is careful evaluation important?
Careful evaluation helps distinguish primary psychiatric illness from neurologic, infectious, inflammatory, autonomic, or multisystem causes of symptoms.
Clinical Takeaway
Lyme disease may involve neuropsychiatric symptoms including anxiety, depression, cognitive dysfunction, brain fog, autonomic symptoms, and sensory hypersensitivity. These symptoms can significantly affect quality of life and occupational functioning.
Careful evaluation is important when psychiatric or cognitive symptoms occur alongside fatigue, pain, neurologic complaints, autonomic dysfunction, or possible tick exposure.
Related Articles
These related articles explore neurologic Lyme disease, persistent symptoms, autonomic dysfunction, diagnostic challenges, and recovery.
Neurologic Lyme Disease
Post-Treatment Lyme Disease Syndrome
Autonomic Dysfunction and Lyme Disease
Lyme Disease Misdiagnosis
Recovery From Lyme Disease
References
- Biniaz-Harris N, Kuvaldina M, Fallon BA. Neuropsychiatric Lyme Disease and Vagus Nerve Stimulation. Antibiotics (Basel). 2023;12(9):1347.
- Šegždaitė G, Aliukonytė O, Pociūtė K. Neuropsychiatric Manifestations of Lyme Disease: A Literature Review of Psychiatric and Cognitive Impacts. Acta Med Litu. 2025;32(1):6-21.
- Fallon BA, Nields JA. Lyme disease: a neuropsychiatric illness. J Neuropsychiatry Clin Neurosci. 2001;13(4):500-507.
- Novak P, Felsenstein D, Mao C, et al. Association of small fiber neuropathy and post treatment Lyme disease syndrome. PLoS One. 2019;14(2):e0212222.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
My husband was diagnosed with Lyme and Babesia about 9 years ago. He has been undergoing treatment ever since. He changed providers last year and his new provider wants him to be re-tested by Igenex. I’m concerned that if the tests are only IGG positive she will not continue to treat him. Are you aware of any methods to “provoke” activity to get a positive (IGM) result? Thank you!
I don’t have a way to provoke an IgM. Some doctors dismiss the IgM if someone has been ill for more than a month. Your doctor will have to use clinical judgment at the Igg stays positive even if the infection has resolved. Call my office at 914 666 4665 if you have any questions.
My 28 year old daughter is having panic attacks almost daily. She experienced childhood trauma and was also diagnosed with Lyme disease in 2015 but is not able to complete treatment due to the onset of anxiety and panic around treatments and her physical symptoms. Can you recommend an inpatient treatment center that can address both the mental/emotional and physical issues?
I work with complex presentations in my practice. I understand how hard it is to find the right in-patient program. I don’t know of any programs. I have patients that have had an in patients experience but they have found it difficult to find a doctor with experience treating Lyme disease with psychiatric issues.
Dr Cameron,
Thank you for what you do for the Lyme community! I was diagnosed with Babesia Duncani and Lyme by IGENEX labs in Feb 2020. I started treatement the first week of March with DOXY Azithromycin Ceftin and Mepron. My symptoms felt more neurological in June and my LLMD tested me for BART through Galaxy and I was PCR positive. We then stopped my babesia treatment and focused my regiment on Bart and I tested clear of BART in August and September through IGENEX W-Blot, Galxay tripple draw, and T-lab. However My babisia titer was higher than in Feb (340). I was feeling good through September- October so I was taken off antibiotics. In late October I started to develop that odd neurological anxiety. My symptoms now are anxiety, shortness of breath, slight heart palpitations, depression, neurological slight cognitive impairment. My LLMD thinks that I have lyme or BART persisters and is putting me on Horowitz’s Double Dapsone protocol. (Dapsone build to 200MG a day, Minocycline, Bacrtrim DS, Oregano oil, AlliMax, and I will take 50mg of Methylene blue a day for the last 4 weeks of treatment). My question, Will this treatment also address my Babesia Duncani? Should I address Babesia prior to heavy Bart and Lyme protocol?
I do not believe your proposed combination works for Babesia. I typically return to Babesia before the new protocol. Other doctor disagree.
Caught Lyme on east coast 2009. Was prescribed 10 days of doxycycline right when I found the bullseye. (4 days after tick removal). Physical symptoms went away within 2 weeks. A year later, came down with OCD symptoms (first time ever- I was 43 years old). Had a death in the family during that year as well and attributed OCD to that. But wonder if it could be Lyme. Last Lyme test I had was in 2015 I believe and it was still showing positive for IgM but not IgG. (So looks like recent infection in my blood work). Could Lyme be causing my mental health issues or just coincidence? Therapy has helped some, SSRIs made me worse, but a decade later, I’m miserable emotionally. Doctors just chalk it up to emotional trauma but I can’t understand why I can’t seem to get better., and why such a late onset in life. I don’t have any physical symptoms.
I don’t know where to turn. I live in the Midwest so very few deal with Lyme much. I tried someone in Maryland and they just said “well sometimes you don’t seroconvert, keep an eye on your heart just in case”. Another doctor asked if maybe I had syphilis. (That one cracked me up. I know you can get a false positive for Lyme with syphilis, but I found it funny).
Any advice would be so appreciated.
I find it difficult to determine if a tick-borne illness is part of the problem. The tests are not as reliable as I would like. An IgM western blot test can come and go in some patients without ever developing an IgG western blot test. I advise my patients to continue their psychiatric care while looking a second time at a tick borne illness.
Tet books from Dr. Jay Davidson, Dr. Horowitz. Lookup Dr Buhner, join fb group “Microbe Formulas Detox Heroes”. Join Mivrobe Forumulas website for a wealth of videos. For my daughter the physical healing began with functional medicine. Find a lyme literate medical doctor (LLMD) is another option
Hello
I received the 2nd moderna vaccine. The next morning I had a stiff neck and back and headaches. Also, a lot of anxiety. I was treated for lyme 5 years for over 2 years. My symptoms approved. Could the vaccine make my lyme symptoms reappear? Thank you
The symptoms following a COVID-19 can resemble symptoms of Lyme disease even in patients without a history of Lyme disease. I have patients and readers of my blog who are sharing their experience. It is hard to know what symptoms are from the COVID-19 vaccine or a flare-up of Lyme disease. Some Lyme disease patients face flare-ups with or without a vaccine. Many of my patients and readers have suffered from immune issues related to Lyme disease. My patients and readers are only making these tough decisions given the severity of COVID-19 in some individuals.
Hi Dr. Cameron,
My daughter suffered from Lyme’s disease and mononucleosis concurrently when she was in middle school. Approximately 2 years later, she developed sudden onset of severe anxiety and depression. Assay shows that she still has a few positive bands, which are not enough to warrant treatment according to her PCP. My daughter has now graduated high school and her psych symptoms are so severe that she cannot function at all. A friend of mine has a teenage daughter who experienced similar severe psychiatric symptoms after Lyme’s disease and mono on a similar timeline. Do you think there could be a relationship between Lymes/mono and psychiatric illness?
I have seen patients in my practice with the same presentations. Others have too. Here is a blog https://danielcameronmd.com/dont-be-mislead-patients-can-have-both-mono-and-lyme-disease/
The tests are not so reliable.
Hi Dr. Cameron,
My daughter suffered from Lyme’s disease and mononucleosis concurrently when she was in middle school. Approximately 2 years later, she developed sudden onset of severe anxiety and depression. Assay shows that she still has a few positive bands, which are not enough to warrant treatment according to her PCP. My daughter has now graduated high school and her psych symptoms are so severe that she cannot function at all. A friend of mine has a teenage daughter who experienced similar severe psychiatric symptoms after Lyme’s disease and mono on a similar timeline. Do you think there could be a relationship between Lymes/mono and psychiatric illness?